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// Nailing the core - a Perfect Practice article

by Lisa Champion and Anna-Louise Bouvier

We think it’s a fair call to say that ‘core stability’
has myriad definitions and interpretations in the
worldwide fitness industry. Not only do personal
trainers have many different concepts and ideas about what
constitutes core stability, but there is a wide range of research into the topic, some of it with quite conflicting results.

In the PERFECT PRACTICE™ Training System: core control, we define it
as: ‘The ability to maintain balanced alignment as you move’.

This can also be called ‘optimal dynamic control’. Notice that the
word ‘stability’ is not used at all. One reason for this is that trainers
often think that to increase ‘stability’ clients require more ‘rigidity’.
This is not necessarily true, nor is it functionally ideal (see the
Autumn 2008 Network magazine for a full article on this topic).

In 2006, we developed the CIRCLE OF CONTROL™ model
for better understanding core control (the Circle of Control
Chart can be downloaded in pdf format from the Member’s
Gymbag section of the Network web site). In this model we
attempt to include the range of research by defining three levels of core control (see Table A).

So, given these levels of core control, the $64,000,000
question is: can you, as a trainer, assess your client at each of
these levels and, if their core control is lacking, do you have
the skill to retrain them at the required levels? Also, do you
understand how a lack of core control, at any level, is affecting
your client’s performance and injury risk?

A great first step in your client evaluation is to determine the
likelihood of poor core control based on verbal assessment.

Anna-Louise developed the 1-2-3-4 Core Assessment model
in 2005 for use in her Physiocise program. This brilliant system
provides a real advancement in the understanding of what
can influence core control. The premise of the system is that if
any one part of the core unit is compromised, the entire unit is
more likely to undergo a core ‘crash’, causing a loss of form and a
higher potential for injury. The core unit is made up of four parts;
a lid, a front wall, a back wall and a floor. Table B shows the things
that can cause each part of the core to be compromised.

What does the 1-2-3-4 Core Assessment tell you?

For each part of the core unit that is compromised, give
your client one point. The higher their score out of four,
the stronger the likelihood that they will have difficulty
‘switching their core on’ (you will generally find your clients
who suffer from back pain will always have a score higher
than 1). If this is the case, you will have to incorporate
some low-level core retraining to establish a better brain
connection to their LMS, and then carefully assess their
ability to maintain optimal dynamic control as levels of work
progress to medium and high.

Educating your client as to what can cause a core crash is
a vital part of getting them to start thinking independently
about their form and function. As they begin to understand
what elements influence their core control, they will start to take
more personal responsibility for their breathing, posture, daily
habits, and overall body awareness.

Notice that some of the elements are long-term problems,
deeply rooted in your client’s medical history, while others are
acute conditions like having a high stress level, a gastric bug,
or menstruating. With this in mind, it’s important to know
your client’s medical history but also to keep checking in with
their status on a session-by-session basis.

* You are encouraged to incorporate the 1-2-3-4 Core Assessment questions in your client evaluations. The concept
and term 1-2-3-4 Core Assessment, however, is Anna-Louise’s
intellectual property and must be attributed to the PERFECT
PRACTICE™ Training System.

Ligament laxity assessment

A second valuable assessment tool is understanding your
client’s genetic ligament laxity. Some people are born with
looser collagen than others, making their ligaments more
lax. Anna-Louise calls these people ‘Floppies’. People who
are higher on the Floppy scale (also called hypermobile) have
more difficulty controlling their optimal alignment. Think
of them as having ‘cooked spaghetti syndrome’ – that is, an inability to hold themselves up against the forces of gravity.

To determine whether your client is a Floppy, include these
questions in your initial client assessment:
• Were you considered quite flexible as a child?
• Could you do the splits as a child?
• Could you do back bends?
• Have you ever been told you were double jointed?
• Do you tend to fidget a lot?
• Do your joints click a lot?

If your client answers yes to several of these questions,
chances are they are a Floppy. You can also do a quick
physical assessment by asking your client to touch their
toes. Floppy clients (without pain issues) can generally fold
themselves in half and quite comfortably place their palms
on the ground. So, what do you learn from this and how is it relevant to core control?

Firstly, it’s important to understand that Floppies will
always need a heavy emphasis on core control. They need to
understand that it is their genetic predisposition that makes it
difficult to maintain optimal alignment, and hence they need
a strong brain/body connection. They need to be taught how
to establish this connection through their breathing and their
postural awareness which, in time, becomes the foundation of all their movement patterns.

Floppies get into trouble when they compensate for their
laxity through stiffening and tightening their global, or outer,
muscles. As these muscles are not designed to work all the time, when overused they eventually become fatigued and
begin to spasm, leading to back and neck pain. Floppies who
have this compensation pattern will tell you that they are
always tight and feel the need to stretch – a sure sign that the balance between their LMS and GMS has gone askew.

When exercising, Floppies will tend to use their GMS as a ‘first
line of defence’, stiffening and tightening to achieve optimal
alignment at all levels of challenge, rather than being able to differentiate the body’s requirements for a task.

It is important to understand that Floppy clients should
only be stretched strategically, in the areas that have become
chronically tight. Over-stretching your Floppy clients can
actually destabilise them. In contrast, clients who are
genetically more stiff will need more stretching to help them find better range and hence, better performance.

So, there you have two VERBAL ways of assessing your
clients that will give you excellent benchmarks as to their
need to work on core control. In a future article, we will look at the PHYSICAL ways of assessing and retraining low, medium
and high level core control.

Lisa Champion, MSc and Anna-Louise Bouvier, BAppSc (Physio)Lisa is an exercise therapist who specialises in helping clients
maximise their movement potential and minimise their risk through
innovative training. Anna-Louise is a physiotherapist whose practice,
Physiocise, teaches over 750 clients a week how to fix their backs
through exercise and posture education. Together they are the
cocreators of the PERFECT PRACTICE (TM) training system.